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Communications to the Editor |

Pulmonary Embolism in Pernicious Anemia and Hyperhomocysteinemia FREE TO VIEW

Emmanuel Andrès; Jean-Emmanuel Kurtz
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Hôpitaux Universitaires de Strasbourg Strasbourg, France

Correspondence to: Emmanuel Andrès, MD, Service de Médecine Interne, Clinique Médicale B, Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1 place de l’Hôpital à 67 091 Strasbourg Cedex, France; e-mail: emmanuel.andres@chru-strasbourg.fr



Chest. 2003;124(3):1181. doi:10.1378/chest.124.3.1181
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To the Editor:

We read with great interest the article of Caldera et al1 about pulmonary embolism in a patient with pernicious anemia and hyperhomocysteinemia (October 2002). This case report illustrates the potential role of a cobalamin deficiency, here related to pernicious anemia, in the pathogenesis of venous thrombosis, especially in case of preexistent thrombophilia status, herein a G20210A prothrombin gene mutation.

We have previously reported a similar observation in a 40-year-old woman with splenic venous infarction and thrombosis, hyperhomocysteinemia associated with a cobalamin deficiency related to celiac disease, and a preexistent thrombophilic disease: a C677T methyltetrahydrofolate reductase gene mutation.2 In our opinion, the question as to whether cobalamin deficiency may favor the onset of venous thrombosis remains questionable. We have previously reported a retrospective study of a cohort of patients (n = 120) with moderate hyperhomocysteinemia (20 ± 9 μmol/L; extreme, 13 to 42 μmol/L) related to cobalamin deficiency (145 ± 37 pmol/L; extreme, 45 to 200 pmol/L).3 In our study, we have observed 2.5% of venous thrombosis (all deep venous thrombosis and pulmonary embolism) in the group of patients with hyperhomocysteinemia related to cobalamin deficiency vs 2.6% in a control group (p value not significant).4 We suggest that future studies should be undertaken to definitively link hyperhomocysteinemia and cobalamin deficiency to venous thrombosis.

Caldera, A, Mora, J, Kotler, M, et al (2002) Pulmonary embolism in a patient with pernicious anemia and hyperhomocysteinemia.Chest122,1487-1488. [PubMed] [CrossRef]
 
Andrès, E, Pflumio, F, Knab, MC, et al Splenic thrombosis and celiac disease: a fortuitous association?Presse Med2000;29,1933-1934. [PubMed]
 
Andrès, E, Goichot, B, Schlienger, JL Food-cobalamin malabsorption: a usual cause of vitamin B12 deficiency.Arch Intern Med2000;160,2061-2062. [PubMed]
 
Andrès, E, Perrin, AE, Vinzio, S, et al L’hyperhomocystéinémie modérée liée à une carence en vitamine B12 est-elle un facteur de thrombophilie? Etude rétrospective de 120 observations. Rev Med Interne. 2001;;22(suppl 4) ,.:522s
 

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References

Caldera, A, Mora, J, Kotler, M, et al (2002) Pulmonary embolism in a patient with pernicious anemia and hyperhomocysteinemia.Chest122,1487-1488. [PubMed] [CrossRef]
 
Andrès, E, Pflumio, F, Knab, MC, et al Splenic thrombosis and celiac disease: a fortuitous association?Presse Med2000;29,1933-1934. [PubMed]
 
Andrès, E, Goichot, B, Schlienger, JL Food-cobalamin malabsorption: a usual cause of vitamin B12 deficiency.Arch Intern Med2000;160,2061-2062. [PubMed]
 
Andrès, E, Perrin, AE, Vinzio, S, et al L’hyperhomocystéinémie modérée liée à une carence en vitamine B12 est-elle un facteur de thrombophilie? Etude rétrospective de 120 observations. Rev Med Interne. 2001;;22(suppl 4) ,.:522s
 
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